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Back pain

Back pain is a sign of diseases of the musculoskeletal system

Almost all adults have experienced back pain during their lifetime. This is a very common problem that can be based on different reasons that we will analyze in this article.

Causes of back pain

All causes of back pain can be divided into groups:

  1. Musculoskeletal:

    • Osteochondrosis;
    • herniated disc;
    • Compression radiculopathy;
    • Spondylolisthesis;

  2. Inflammatory, including infectious:

    • Osteomyelitis
    • Tuberculosis

  3. neurological;

  4. Damages;

  5. Endocrinological;

  6. Vascular;

  7. Tumor.

At the first visit to the doctor with back pain, the specialist must determine the cause and type of pain, paying special attention to "red flags" - possible manifestations of potentially dangerous diseases. "Red flags" refer to a set of specific complaints and anamnesis data that require an in-depth examination of the patient.

"Red Flags":

  • patient's age at the time of pain onset: younger than 20 or older than 50;
  • a serious spinal cord injury in the past;
  • the appearance of pain in patients with cancer, HIV infection or other chronic infectious processes (tuberculosis, syphilis, Lyme disease and others);
  • fever;
  • weight loss, loss of appetite;
  • unusual localization of pain;
  • increased pain in a horizontal position (especially at night), in a vertical position - weakness;
  • no improvement for 1 month or more;
  • dysfunction of the pelvic organs, including urination and defecation disorders, numbness in the perineum, symmetrical weakness in the lower extremities;
  • alcoholism;
  • the use of narcotic drugs, especially intravenous;
  • treatment with corticosteroids and/or cytostatics;
  • with pain in the neck, the pulsating nature of the pain.

The presence of one or more signs in itself does not mean the presence of a dangerous pathology, but it requires a doctor's attention and diagnosis.

Back pain is divided into the following forms according to duration:

  • peak- pain lasting less than 4 weeks;
  • subacute- pain lasts from 4 to 12 weeks;
  • chronic- pain that lasts 12 weeks or more;
  • pain relapse- recurrence of pain if it has not occurred within the last 6 months or more;
  • worsening of chronic painPain recurrence less than 6 months after previous episode.

Diseases

Let's talk more about the most common musculoskeletal causes of back pain.

Osteochondrosis

This is a disease of the spine, which is based on wear and tear of the vertebral discs and subsequently the vertebrae themselves.

Is osteochondrosis a pseudodiagnosis? - Does not. This diagnosis is found in the International Classification of Diseases ICD-10. Currently, doctors are divided into two camps: some believe that such a diagnosis is wrong, others, on the contrary, often diagnose osteochondrosis. This situation arose due to the fact that foreign doctors understand osteochondrosis as a disease of the spine in children and adolescents associated with growth. But this term specifically refers to a degenerative disease of the spine in people of all ages. Also frequently established diagnoses are dorsopathy and dorsalgia.

  • Dorsopathy is a pathology of the spine;
  • Dorsalgia is a benign, non-specific back pain that spreads from the lower cervical vertebrae to the sacrum, which can also be caused by damage to other organs.

The spine has several sections: cervical, thoracic, lumbar, sacral and coccygeal. Pain can occur in any of these areas, which is described by the following medical terms:

  • Cervicalgia is pain in the cervical spine. The intervertebral discs in the cervical region have anatomical features (intervertebral discs are absent in the upper section, and in other sections they have a weakly expressed nucleus pulposus with its regression on average by 30 years), which makes them more susceptible to stress and damage, which leads to stretching of ligaments and early development of degenerative changes;
  • Thoracalgia - pain in the thoracic spine;
  • Lumbodynia - pain in the lumbar spine (lower back);
  • Lumboischialgia is pain in the lower back that radiates to the leg.

Factors leading to the development of osteochondrosis:

  • heavy physical work, lifting and moving heavy loads;
  • low physical activity;
  • long sedentary work;
  • long stay in an uncomfortable position;
  • long work at the computer with a non-optimal screen location, which creates a strain on the neck;
  • violation of posture;
  • congenital structural features and anomalies of the spine;
  • weakness of back muscles;
  • high growth;
  • excess body weight;
  • diseases of the joints in the legs (gonarthrosis, coxarthrosis, etc. ), flat feet, clubfoot, etc. ;
  • natural wear and tear with age;
  • smoking.

disc herniationis a projection of the nucleus of the intervertebral disc. It may be asymptomatic or cause compression of surrounding structures and manifest as a radicular syndrome.

Symptoms:

  • violation of the range of motion;
  • feeling of stiffness;
  • muscle tension;
  • radiation of pain to other areas: arms, shoulder blade, legs, groin, rectum, etc.
  • "shots" of pain;
  • numbness;
  • crawling sensation;
  • muscle weakness;
  • pelvic disorders.

Localization of pain depends on the level where the hernia is located.

Disc herniations often go away on their own within 4-8 weeks on average.

Compression radiculopathy

Radicular (radicular) syndrome is a complex of manifestations that occurs due to compression of the spinal roots at their departure from the spinal cord.

Symptoms depend on the level at which the compression of the spinal cord occurs. Possible manifestations:

  • pain in the extremity of a shooting nature with radiation to the fingers, aggravated by motion or coughing;
  • numbness or a sensation of flies crawling in a certain area (dermatome);
  • muscle weakness;
  • spasms in the back muscles;
  • violation of the strength of reflexes;
  • positive symptoms of tension (the occurrence of pain with passive flexion of the limbs)
  • limitation of spinal mobility.

Spondylolisthesis

Spondylolisthesis is the displacement of the upper vertebra in relation to the lower one.

This condition can occur in both children and adults. Women are more often affected.

Spondylolisthesis may not cause symptoms with mild displacement and may be an incidental radiographic finding.

Possible symptoms:

  • feeling of discomfort
  • pain in the back and lower limbs after physical work,
  • weakness in the legs
  • radicular syndrome,
  • decreased pain and tactile sensitivity.

The progression of vertebral displacement can lead to lumbar stenosis: the anatomical structures of the spine degenerate and grow, gradually leading to compression of nerves and blood vessels in the spinal canal. Symptoms:

  • constant pain (both at rest and in motion),
  • in some cases, the pain may decrease in a lying position,
  • pain is not aggravated by coughing and sneezing,
  • the nature of the pain from pulling to very strong,
  • dysfunction of the pelvic organs.

In the case of a strong displacement, compression of the arteries can occur, as a result of which the blood supply to the spinal cord is disturbed. This is manifested by a sharp weakness in the legs, a person can fall.

Diagnostics

Collection of complaintshelps the doctor to suspect the possible causes of the disease, to determine the localization of pain.

Pain intensity assessment- a very important stage of diagnosis that allows you to choose a treatment and evaluate its effectiveness over time. In practice, the Visual Analogue Scale (VAS) is used, which is practical for the patient and for the doctor. In this case, the patient rates the severity of pain on a scale from 0 to 10, where 0 points is no pain and 10 points is the worst pain a person can imagine.

Interviewallows you to identify factors that cause pain and destruction of the anatomical structures of the spine, to identify movements and positions that cause, intensify and relieve pain.

Physical examination:assessment of the presence of spasms in the back muscles, determination of the development of the musculoskeletal system, exclusion of the presence of signs of an infectious lesion.

Assessment of neurological status:muscle strength and its symmetry, reflexes, sensitivity.

March test:performed in cases of suspected lumbar stenosis.

Important!Patients without "red flags" with a classic clinical picture are not recommended to carry out further examinations.

Radiography:performed with functional tests for suspected instability of the spinal structures. However, this diagnostic method is uninformative and is mainly carried out with limited financial resources.

Computed tomography (CT) and/or magnetic resonance imaging (MRI):the doctor will prescribe based on clinical data, since these methods have different indications and advantages.

CT

MR
  • Evaluates bony structures (vertebrae).

  • Allows you to see the later stages of osteochondrosis, where bone structures are affected, compression fractures, destruction of the vertebrae in metastatic lesions, spondylolisthesis, anomalies in the structure of the vertebrae, osteophytes.

  • It is also used for contraindications to MRI.
  • Evaluates soft tissue structures (intervertebral discs, ligaments, etc. ).
  • Allows you to see the first signs of osteochondrosis, intervertebral hernia, diseases of the spinal cord and roots, metastases.

Important!In most people, in the absence of complaints, degenerative changes in the spine are detected according to instrumental examination methods.

Bone densitometry:performed to assess bone density (confirmation or exclusion of osteoporosis). This study is recommended for postmenopausal women at high risk of fractures and always at the age of 65, regardless of risk, men over 70, patients with fractures with minimal trauma history, long-term use of glucocorticosteroids. The 10-year risk of fracture is assessed using the FRAX scale.

Bone scintigraphy, PET-CT:performed in the presence of suspicion of oncological disease according to other examination methods.

treatment of back pain

For acute pain:

  • painkillers are prescribed in a course, mainly from the group of non-steroidal anti-inflammatory drugs (NSAIDs). The specific drug and dose is chosen depending on the severity of the pain;
  • maintaining moderate physical activity, special exercises to relieve pain;

    Important!Physical inactivity with back pain increases pain, prolongs the duration of symptoms, and increases the likelihood of chronic pain.

  • muscle relaxants for muscle spasms;
  • it is possible to use vitamins, but their effectiveness according to various studies remains unclear;
  • manual therapy;
  • analysis of lifestyle and elimination of risk factors.

For subacute or chronic pain:

  • use of pain relievers as needed;
  • special physical exercises;
  • assessment of the psychological state, as it can be a significant factor in the development of chronic pain, and psychotherapy;
  • drugs from the group of antidepressants or antiepileptic drugs for the treatment of chronic pain;
  • manual therapy;
  • analysis of lifestyle and elimination of risk factors.

In radicular syndrome, blockades (epidural injections) or intraosseous blocks are used.

Surgical treatment is indicated with a rapid increase in symptoms, the presence of spinal cord compression, with significant stenosis of the spinal canal and the ineffectiveness of conservative therapy. Acute surgical treatment is performed in the presence of: pelvic disorders with numbness in the anogenital region and increasing weakness in the feet (cauda equina syndrome).

Rehabilitation

Rehabilitation should be started as soon as possible and have the following goals:

  • improving the quality of life;
  • elimination of pain, and if it is impossible to completely eliminate it - relief;
  • restoration of function;
  • rehabilitation;
  • self-service and safe driving training.

Basic rules for rehabilitation:

  • the patient must feel his own responsibility for his health and compliance with the recommendations, however, the doctor must choose the treatment methods and rehabilitation that the patient can comply with;
  • systematic training and compliance with safety rules when performing exercises;
  • pain is not an obstacle to exercise;
  • a relationship of trust must be established between the patient and the doctor;
  • the patient should not focus and focus on the cause of pain in the form of structural changes in the spine;
  • the patient must feel comfortable and safe when performing movements;
  • the patient must feel the positive impact of rehabilitation on his condition;
  • the patient must develop pain response skills;
  • the patient must associate movement with positive thoughts.

Rehabilitation methods:

  1. Walks;
  2. Physical exercises, gymnastics, gymnastics programs in the workplace;
  3. Individual orthopedic devices;
  4. Cognitive behavioral therapy;
  5. Patient education:
    • Avoid excessive physical activity;
    • Combating low physical activity;
    • Exclusion of prolonged static loads (standing, being in an uncomfortable position, etc. );
    • Avoid hypothermia;
    • Sleep organization.

Prevention

Optimal physical activity: strengthens the muscle frame, prevents bone resorption, improves mood and reduces the risk of cardiovascular accidents. The most optimal physical activity is walking more than 90 minutes a week (at least 30 minutes at a time, 3 days a week).

For prolonged sedentary work, it is necessary to take breaks for a warm-up every 15-20 minutes. minute and follow the rules for sitting.

Life hack:how to sit

  • avoid overly upholstered furniture;
  • the legs must rest on the floor, which is achieved by the height of the chair being equal to the length of the lower leg;
  • it is necessary to sit at a depth of up to 2/3 of the length of the hips;
  • sit straight, maintain correct posture, the back should sit tight against the back of the chair to avoid straining the back muscles;
  • the head, when reading a book or working at a computer, must have a physiological position (look straight ahead, and not constantly down). To do this, it is recommended to use special stands and install the computer monitor at the optimal height.

For prolonged standing work, it is necessary to change position every 10-15 hours. minute, alternately changing support legs, and if possible get in place and move.

Avoid prolonged lying down.

Life hack:how to sleep

  • sleep better on a semi-rigid surface. If possible, you can choose an orthopedic mattress so that the spine maintains physiological curves;
  • the pillow must be soft enough and of medium height to avoid stress on the neck;
  • when sleeping in a lying position, it is recommended to put a small pillow under the stomach.

Quit smoking: If you are having difficulty, see your doctor who will refer you to a smoking cessation program.

Frequently asked questions

  1. I use ointments with glucocorticosteroids. Am I at increased risk of osteochondrosis or osteoporosis?

    None. External glucocorticosteroids (ointments, creams, gels) do not penetrate in significant quantities into the systemic circulation and therefore do not increase the risk of developing these diseases.

  2. In every case of a herniated disc, is surgery necessary?

    None. Surgical treatment is performed only if indicated. On average, only 10-15% of patients need surgery.

  3. Should you stop exercising if you have back pain?

    None. If, as a result of further examination methods, the doctor does not find anything that will significantly limit the degree of stress on the spine, then it is possible to continue playing sports, but after going through a course of treatment and adding certain exercises from the course of physiotherapy exercises and swimming.

  4. Can back pain go away forever if I have a herniated disc?

    They can, after a course of productive conservative therapy, subject to further implementation of the recommendations of the attending neurologist, compliance with the rules of prevention, regular exercise therapy and swimming.